OBJECTIVE: To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. METHODS: We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. RESULTS: Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P < 0.001). CONCLUSION: Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.
Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Diagnostic Imaging ; Observational Study ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Radiography ; Subclavian Vein ; Thorax ; Ultrasonography*

PURPOSE: Korean Acuity and Triage Scale (KTAS) has been used nationally since 2016 for triage in emergency departments. After the newly developed triage tool was applied, there have been few studies of the validity of pediatric KTAS. The purpose of this study was to evaluate the validity of KTAS in children under the age of 15 who visited a single children's hospital. METHODS: This retrospective study was conducted on 7,011 pediatric patients under the age of 15 who visited a single child hospital between January 1 and December 31, 2016, the difference in the admission rate, intensive care unit admission rate, length of stay in the emergency department, and total hospital cost in emergency department were analyzed using the KTAS level. RESULTS: The number of patients triaged as KTAS IV was highest with 48.2%. The length of stay was longest in KTAS I and shortest in KTAS V. The medical cost in emergency department was highest in KTAS I and lowest in KTAS V. All dependent variables except for the intensive care unit admission rate showed significant differences according to the KTAS level. CONCLUSION: When the KTAS of the newly developed five level triage system was applied to pediatric patients, there were statistically significant difference in hospitalization, length of stay in emergency department, and total cost to the emergency department according to the KTAS level. Therefore, it will be necessary to evaluate the validity of KTAS through multicenter studies including hospitals with various characteristics.
Child ; Emergencies* ; Emergency Service, Hospital* ; Hospital Costs ; Hospitalization ; Humans ; Intensive Care Units ; Length of Stay ; Retrospective Studies ; Triage*

Gastric rupture after cardiopulmonary resuscitation (CPR) is a rare complication. In most cases, it is associated with bystander-provided CPR, bag-mask ventilation, and difficult airway management. To the best of our knowledge, there has been only one previous case report in the literature regarding gastric rupture after CPR via supraglottic airway. We present a case of a gastroesophageal junction rupture secondary to CPR with supraglottic airway. Healthcare providers should consider that gastric rupture can be a complication from performing CPR.
Airway Management ; Cardiopulmonary Resuscitation* ; Esophagogastric Junction* ; Health Personnel ; Humans ; Laryngeal Masks ; Pneumoperitoneum* ; Rupture* ; Stomach Rupture ; Ventilation

OBJECTIVE: We aimed to evaluate the factors influencing treatment option selection among urologists for patients with ureteral stones, according to the stone diameter and location. METHODS: We retrospectively reviewed the records of 360 consecutive patients who, between January 2009 and June 2014, presented to the emergency department with renal colic and were eventually diagnosed with urinary stones via computed tomography. The maximal horizontal and longitudinal diameter and location of the stones were investigated. We compared parameters between patients who received urological intervention (group 1) and those who received medical treatment (group 2). RESULTS: Among the 360 patients, 179 (49.7%) had stones in the upper ureter and 181 (50.3%) had stones in the lower ureter. Urologic intervention was frequently performed in cases of upper ureteral stones (P<0.001). In groups 1 and 2, the stone horizontal diameters were 5.5 mm (4.8 to 6.8 mm) and 4.0 mm (3.0 to 4.6 mm), stone longitudinal diameters were 7.5 mm (6.0 to 9.5 mm) and 4.4 mm (3.0 to 5.5 mm), and ureter diameters were 6.4 mm (5.0 to 8.0 mm) and 4.7 mm (4.0 to 5.3 mm), respectively (P<0.001). The cut-off values for the horizontal and longitudinal stone diameters in the upper ureter were 4.45 and 6.25 mm, respectively (sensitivity 81.3%, specificity 91.4%); those of the lower ureter were 4.75 and 5.25 mm, respectively (sensitivity 79.4%, specificity 79.4%). CONCLUSION: The probability of a urologic intervention was higher for patients with upper ureteral stones and those with stone diameters exceeding 5 mm horizontally and 6 mm longitudinally.
Cohort Studies* ; Emergency Service, Hospital ; Humans ; Renal Colic ; Retrospective Studies* ; Sensitivity and Specificity ; Ureter* ; Ureteral Calculi ; Urinary Calculi

PURPOSE: Inadequate treatment of pain, which has been termed as “oligoanalgesia”, appears to be common phenomenon the emergency department (ED). In order to improve pain recognition and management, a study concerning physician characteristics on pain and pain management is needed. METHODS: This study was based on a survey that targeted emergency medicine doctors from September to November 2015 (the response rate was 7%). Firstly, the survey showed that physicians preferred medicating on five diseases abdominal pain, cancer, simple musculoskeletal disease, trauma, headache in the ED. Secondly, it demonstrated the criteria used to choose the analgesic treatment in accordance with each disease and the level of pain, which is determined using a numerical rating scale (NRS). RESULTS: In the cases of abdominal pain that requires surgery, cancer pain, and multiple trauma, physicians preferred using an opioid as the first medication, while non steroidal anti inflammatory drugs (NSAIDs) are prescribed in most of the other cases. Meperidine was the preferred choice as the opioid. For almost diseases, the NSAIDs are selected in the lower NRS cases over the opioid. Physicians deal with pain of patients who are already diagnosed with specific diseases, such as cancer, while they avoid managing pain from those patients who have not been definitively diagnosed with a specific disease. CONCLUSION: Physicians in the ED prefer the use of NSAIDs as the analgesic treatment, in particular, prescribing meperidine as the preferred opioid. However, it seems that they are hesitant to manage pain without a clear diagnosis.
Abdominal Pain ; Analgesics ; Anti-Inflammatory Agents, Non-Steroidal ; Diagnosis ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Headache ; Humans ; Meperidine ; Multiple Trauma ; Musculoskeletal Diseases ; Pain Management

PURPOSE: Purpose: We compared the outcomes of training between the use of voice-advisory manikin (VAM) and instructor-led (IL) courses with respect to the acquisition of initial cardio-pulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and randomly distributed them into two groups: the IL group (n=41) and the VAM group (n=37). In the IL group, participants were trained in “single-rescuer, adult CPR” in accordance with the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the two groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; p=0.396). CONCLUSION: Both methods the IL training using a practice-while-watching video and the VAM training facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Thorax ; Ventilation ; Voice*

OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). CONCLUSION: Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Education ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Teaching Materials ; Thorax ; Ventilation ; Voice*

BACKGROUND: Cardiac enzymes such as creatine kinase-MB, troponin I, and brain natriuretic peptide (BNP) are thought to be useful prognostic factors in patients with acute ischemic stroke. This study investigated the efficacy of cardiac biomarkers as prognostic factors. METHODS: We reviewed patients with acute ischemic stroke whose cardiac biomarkers had been measured and who were admitted to our hospital between January 2012 and December 2013. The cardiac biomarkers were measured within 24 hours after admission to the emergency room. We evaluated the clinical characteristics and compared the outcomes of the patients based on their cardiac biomarkers. RESULTS: The following cardiac biomarkers were measured in 219 patients with acute ischemic stroke: creatine kinase-MB (n=218), troponin I (n=219), and BNP (n=143). Statistically significant differences were observed in older age (68.77+/-12.42 vs. 74.59+/-6.68, p<0.05), insula involvement (30.5% vs. 59.1%, p<0.01), and higher BNP (259.75+/-422.65 vs. 667.06+/-1093.22, p<0.01). CONCLUSIONS: These results suggest that measuring all cardiac biomarkers may be not effective in determining the prognosis of acute ischemic stroke. However, BNP may be a superior to troponin I in predicting the prognosis.
Biomarkers ; Cerebral Infarction ; Creatine ; Emergency Service, Hospital ; Humans ; Natriuretic Peptide, Brain ; Prognosis ; Stroke* ; Troponin I

BACKGROUND: Cardiac enzymes such as creatine kinase-MB, troponin I, and brain natriuretic peptide (BNP) are thought to be useful prognostic factors in patients with acute ischemic stroke. This study investigated the efficacy of cardiac biomarkers as prognostic factors. METHODS: We reviewed patients with acute ischemic stroke whose cardiac biomarkers had been measured and who were admitted to our hospital between January 2012 and December 2013. The cardiac biomarkers were measured within 24 hours after admission to the emergency room. We evaluated the clinical characteristics and compared the outcomes of the patients based on their cardiac biomarkers. RESULTS: The following cardiac biomarkers were measured in 219 patients with acute ischemic stroke: creatine kinase-MB (n=218), troponin I (n=219), and BNP (n=143). Statistically significant differences were observed in older age (68.77+/-12.42 vs. 74.59+/-6.68, p<0.05), insula involvement (30.5% vs. 59.1%, p<0.01), and higher BNP (259.75+/-422.65 vs. 667.06+/-1093.22, p<0.01). CONCLUSIONS: These results suggest that measuring all cardiac biomarkers may be not effective in determining the prognosis of acute ischemic stroke. However, BNP may be a superior to troponin I in predicting the prognosis.
Biomarkers ; Cerebral Infarction ; Creatine ; Emergency Service, Hospital ; Humans ; Natriuretic Peptide, Brain ; Prognosis ; Stroke* ; Troponin I

PURPOSE: Many patients complain of pain due to fracture in the emergency department (ED). However, pain management in these patients has not been performed well. The objective of this study is to describe analgesic utilization and assess factors associated with analgesic use in patients with isolated long-bone fractures during the ED visit. METHODS: We retrospectively reviewed electronic medical records of patients presenting to two EDs with an isolated long bone fracture from January to December 2012. A total of 358 patients were enrolled, and sex, age, arrival route, mechanism of injury, fracture type, fracture location, drug used for pain control, arrival time, physician in charge primary care, and disposition were analyzed. RESULTS: Analgesics were administered to 50% of patients between 20~60 years, whereas 11.3% of patients under 20 years old and 38.7% above 60 years old (p<0.01) received analgesics. Better pain control was achieved in females, young adults, patients cared for by emergency medicine residents, and visits made by emergency medical service or at dawn. CONCLUSION: The pain control rate of children is lower than that of adults in patients with an isolated long bone fracture. Active strategies for pain management are necessary by triage physicians from this time forward.
Adult ; Analgesics* ; Child ; Electronic Health Records ; Emergency Medical Services ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Fractures, Bone* ; Humans ; Pain Management ; Primary Health Care ; Retrospective Studies ; Triage ; Young Adult